But New Zealand Aviation Federation president and New Zealand Aircraft Owners and Pilots Association president Ian Andrews said the medical application process was already robust enough.

The association would lodge a complaint about the recommendation, he said.

“They [TAIC] are over-the-top.”

The only way to prevent cheating in the system was to have a doctor alongside the pilot at all times, he said.

“The medical process, as portrayed by this report, is not flawed.

“I wonder what … would lead to such a list of recommendations when the finding is that a medical factor was clearly not the cause of the accident.”

Private pilots undertook medical examinations annually and commercial pilots every six months. They cost upwards of $500 each time.

Andrews said the system was already “too stringent” on private pilots.

“I’ve had guys that have spent $10,000 on costs of investigations for something that was not even there.”

A mast bump – which is contact between an inner part of a main rotor and the main rotor drive shaft or mast that usually results in the helicopter breaking up in flight – led to the helicopter Combe was flying to crash, however the cause of the bump could not be determined.

In the year before the crash Combe’s GP diagnosed him with depression and anxiety after he had worked in Papua New Guinea.

He was offered a job with helicopter company Over The Top after he stopped taking medication and felt “marked improvements” by September 2015.

Over The Top owner Louisa Patterson’s son died in the crash. She said she was not aware of Combe’s medical history.

“Steve Combe at all times, whilst in his employment with our company, was observed as highly professional, competent and fit to fly.

“Had there been any concerns regarding his fit and proper person status he would not have been entrusted with flying my clients or my son.”

The design of Robinson helicopters was a “significant issue” that had to be addressed, Patterson said.

“Had our boys have been in any other aircraft type, this crash would not have happened.”

There have been more than 100 crashes involving Robinson helicopters since 2015, including 40 involving unexplained in-flight breakups.

Combe had 4527 hours of flight experience when the helicopter crashed, while Patterson Gardner had 10.